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Form M-4-MS

Massachusetts

Annual Withholding Tax Exemption

Department of

Certificate for Nonresident Military Spouse

Revenue

Read instructions below before completing this form. After completion, give the certificate to your employer. Keep a copy for your records.

Employee name

Employee Social Security number

Military servicemember spouse’s name

Spouse’s Social Security number

Street address where you both currently reside

City/Town

State

Zip

Telephone

Name of military servicemember’s station

City/Town

State

Zip

Telephone

Form M-4-MS is to be used only for employees claiming exemption from Massachusetts income tax withholding requirements because they meet the

conditions set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act (P.L. 111-97).

I certify that:

• I am a legal resident (domiciliary) of the state of

;

• My military servicemember spouse’s domicile is the same as mine;

• My spouse is a member of the armed forces and is present in or near Massachusetts in compliance with military orders; and

• I am present in Massachusetts solely to be with my spouse.

I no longer qualify for the exemption as of (date)

Under penalties of perjury, I declare that to the best of my knowledge and belief the above information is true, correct, and complete.

Employee signature

Date

Telephone

Notice to Employers

Domicile

In order to claim domicile in a state other than the state in which you

Employers are not exempt from withholding tax liability for failing to

currently reside you must have proof that you meet one or more of

withhold the proper Massachusetts tax on a military spouse unless

the criteria listed below. If you previously were not a domiciliary of an-

they have a properly completed Massachusetts Form M-4-MS and sat-

other state you cannot claim that state as your domicile merely by

isfy the additional requirements set forth below.

making an election.

Requirements of Employer

Domicile is a place where a person has established permanent resi-

The employee must show the employer an original of the employee’s

dence with an intention to dwell in that place permanently and to return

current military spouse ID and provide a clear photocopy. The em-

to it after absence. An individual has only one state of domicile at any

ployer must ensure that the ID denotes the employee as a current mili-

time and loses his or her current domicile only when he or she estab-

tary spouse. These IDs are reissued every four years; accordingly,

lishes a new domicile. The domicile is created based on performing

the employer may not accept a military ID that is dated more than four

one or more of the following actions.

years before the date on which it is given to the employer. In addition

to a copy of the military spouse ID, the employee must provide to the

Criteria Used to Determine State of Domicile

employer copies of the following:

Property, ownership and residence. Homestead status; the location

of permanent home; mailing address; amount of time spent in a state.

• Department of Defense Form 2058, State of Legal Residence Cer-

tificate of servicemember;

Financial data. Location of bank accounts; where taxpayer qualifies

for unemployment benefits; state where prior resident tax returns

• Most recent LES, Leave and Earnings Statement, of servicemem-

were filed; state where business is conducted; state where wages

ber; and

are earned.

• Servicemember’s current military orders assigning such service-

Licenses and registrations. Where taxpayer is registered to vote;

member to a post of duty in or near Massachusetts.

state driver’s license; state where vehicles are registered; state where

The employer must keep the Form M-4-MS with the employee’s per-

professional licenses are maintained.

sonnel records. If the employer believes the employee has improperly

Affiliations. Location of fraternal, social or athletic memberships;

claimed the Nonresident Military Spouse Residency Withholding Ex-

union membership location; place of worship.

emption, the employer must contact the Department of Revenue.

Family and dependents. Place of family ties for employee, service-

Note: The Form M-4-MS must be validated on an annual basis. The

member spouse and dependents.

spouse must show continued eligibility for the exemption. Scenarios

that will cause the spouse to no longer be eligible include:

Single Domicile Factor Not Sufficient

• Servicemember leaves the service;

No single factor determines a person’s state of domicile; all factors

must be evaluated together.

• Divorce;

A person’s permanent residence, once established, continues as their

• Voluntary physical separation due to duty changes. The service-

state of domicile until they take steps to establish a new domicile in

member’s orders move him or her to a location outside Massachusetts

another state.

where the spouse is allowed to join him or her but chooses not to; or

• Spouse commits an action that clearly establishes Massachusetts

as his or her state of domicile.

printed on recycled paper

Form M-4-Ms - Annual Withholding Tax Exemption Certificate For Nonresident Military Spouse

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